Healthcare Provider Details

I. General information

NPI: 1013498112
Provider Name (Legal Business Name): MACKENZIE DESCLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WORKS WAY
SOMERSWORTH NH
03878-1639
US

IV. Provider business mailing address

7 WORKS WAY
SOMERSWORTH NH
03878-1639
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9399
  • Fax:
Mailing address:
  • Phone: 603-516-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: